The Frontal Lobe

“Every clinical assessment of behavior requires a careful review of frontal lobe functions. Nonetheless, several challenges face behavioral neurologists and neuropsychologists in their clinical attempts to assess the frontal lobes. Whereas an assessment of sensorimotor systems is guided by a relatively well understood pattern of brain-behavior relationships, the frontal lobes are incredibly complex, and because of their extensive interconnections with other neural structures, they control or influence a broad range of behaviors. Injury to the frontal lobes can affect initiation of complex motor behavior, attention, executive functioning, working memory, episodic memory, language, emotions, and behavior.”~ from the chapter “Bedside Frontal Lobe Testing,” of The Human Frontal Lobes.

The frontal lobes are considered our emotional control center and home to our personality. There is no other part of the brain where lesions can cause such a wide variety of symptoms. The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior. The frontal lobes are extremely vulnerable to injury due to their location at the front of the cranium, proximity to the sphenoid wing and their large size. MRI studies have shown that the frontal area is the most common region of injury following mild to moderate traumatic brain injury.

There are important asymmetrical differences in the frontal lobes. The left frontal lobe is involved in controlling language related movement, whereas the right frontal lobe plays a role in non-verbal abilities. Some researchers emphasize that this rule is not absolute and that with many people, both lobes are involved in nearly all behavior.

One of the most common characteristics of frontal lobe damage is difficulty in interpreting feedback from the environment. Perseverating on a response, risk taking, and non-compliance with rules, and impaired associated learning (using external cues to help guide behavior) are a few examples of this type of deficit.The frontal lobes are also thought to play a part in our spatial orientation, including our body’s orientation in space.

One of the most common effects of frontal damage can be a dramatic change in social behavior. A person’s personality can undergo significant changes after an injury to the frontal lobes, especially when both lobes are involved. There are some differences in the left versus right frontal lobes in this area. Left frontal damage usually manifests as pseudodepression and right frontal damage as psuedopsychopathic.

When traumatic brain injury occurs to the frontal area, it is impacting the brain’s largest lobe. Located at the front of each cerebral hemisphere, this lobe is responsible for conscious thought, voluntary movement, and individual personality characteristics. When you are searching for just the right word to say, it is this section of the brain upon which you rely. Damage to this vital lobe can cause impairments in judgment, attention span and organizational ability, as well as a loss of motivation. In addition, the frontal lobes are charged with the task of regulating mood and emotions. Consequently, when they are compromised, a patient may become impulsive, act rashly, and adopt risky behaviors such as substance abuse.

As is the case with other traumatic brain injuries, damage to the frontal lobe most often occurs as a result of vehicle crashes, falls, and firearms. There are over 6 million car accidents in the USA every year, resulting in 3 million injuries, 2 million of which are permanent.

In the case of frontal lobe damage, particular attention will be focused on helping the patient to learn strategies for curbing impulsive behaviors and regulating emotions. Since many of the symptoms of frontal lobe damage are similar to those of attention deficit disorder, researchers are conducting preliminary studies to see if these traumatic brain injury victims respond to Ritalin and other ADHD medications.

Patience and perseverance will beabsolutely essential for all involved. Since frontal lobe damage causes marked deficits in mood, personality and behavior, a patient might have to thoroughly overhaul many of his or her most basic coping and human relations strategies.

Okay, so are you ready for the layman’s terms???

I’ll do my best here to summarize in shorter length what this all means.

The frontal lobe of the brain is usually the part of the that receives the most damage when a person is involved in a vehicle accident. This part of the brain controls the cognitive motor skills that drive us every day. It also controls the part of the brain that deals with emotions. When a fronal lobe injury occurs, then a lot of usual function becomes impaired.

What is fascinating to know is that people who have these kind of brain injuries actually go through a lack of compassion, care, and otherwise loving emotions towards another human being. A spouse for example will have an extremely decreased sex drive. The thought of having sex with their partner after having a frontal lobe injury just no longer interests them. Yet on the other hand, if sexual contact is something that they desire, they are not considerate of their partner’s feelings and they drive for what they want and disregard their partner.

Which is sad because I think that a lot of the times in this particular situation the relationships crumble and fall apart and then totally dissolves. And the person who has suffered the injury begins to think “it’s me, it’s all me… I am no good. I am nothing but a bother to people. I am sorry.”- and so on.

Not only that, their relationships with family, friends, and other people become extremely diminished as well. They seek only what they want without the thought of other people. If it is attention that they want, then they seek it- anytime, anywhere, by any means possible.

Some people with a lesser injury will actually appear to become concerned for the feelings of others but the injury doesn’t allow them to fully understand that what they are really doing is looking for the acceptance from other people that what they are doing, “is okay” with them. And if so, they continue on in this behavior.

They fear that people will run away from them because of their injury. And sometimes that is actually the case. They will come across so frustrating that it breaks the point of the other person and they put an end to it because they are no longer able to handle the situation.

My sister was in a serious vehicle accident and she suffered the same injuries. Luckily she was not injured any more than she was or even killed, just because some asshole decided to leave his house after drinking and get out on the wet roads in the middle of winter where there was actual snowfall in Texas after the sun was gone and the temperatures at night were dipping below freezing.

Yet because I had known about what happens with the frontal lobes when they become damaged, I thought to myself that “this was going to get interesting, or miserable”. I was living with her and her family at the time. And indeed, it became interesting. She got into more arguments with her husband and was frustrated a lot with her son, and with me. The best I could do was try to see where she was coming from and NOT take everything extremely personal because I knew that she has this injury to her brain.

For those of us who know someone with a frontal lobe injury: Taking things personally all of the time is not really the best resort in dealing with the person. Yet it is extremely difficult not to. Patience is the key. Also you should make clear of your boundaries so you are not being taken advantage of all of the time. You shouldn’t fear to tell a person with a brain injury “no”, or “stop”. Set your boundaries and explain them that as much as you still care for them, just because you are telling them “no” does not mean you have stopped caring.

For those who have suffered a frontal lobe injury: Clearly this is not the end of the world. It just means that your world is going to be different than what it was before. I am not a medical professional, so I cannot say if this is possible or not but working on your social behavior could save you a lot of anguish in the long run. Finding a way that is non-intrusive upon your family and friends could greatly benefit you. After all, before the injury, you knew that it was not the right thing to do to be a constant bother towards others. Finding a solid outlet (such as therapy) could definitely help. Yet the entire “woe is me, I’ve got a brain injury” is only going to get you so far before people DO start walking away. And it is not because you have that injury it is because of your impaired behavior. The injury itself has nothing to do with it.

Like I said, I am no professional. So I do not even know if “thinking before you act” is even possible because of the damage sustained. Yet using the injury as a crutch is only going to turn people off, and then eventually turn them away.

Understand your injury and what you can do about it. Once the brain is damaged, there is no cure. A broken arm can heal, but a “broken brain” cannot. So that is why I would suggest to a person that they seek the professional help of a therapist to begin some kind of mental rehabilitation.

It is not an impossibility to have human relations with a person with a frontal lobe injury. But it is safe to say that it is extremely complicated and difficult.

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Thank you for posting this article. My husband received lower left frontal damage a few years ago but wasn’t clearly diagnosed until last summer. He never sought treatment beyond emergency care. Now that we know what’s going on its more understandable but still hard to deal with. Along with feelings of guilt wondering how long I can deal with it. He just lost his job due to the mistakes he’s been making and we no longer have health insurance. I am really overwhelmed trying to deal with everything (we have teens with medical needs) while not taking my husbands behavior and outbursts personal. Such as him saying I’m the most selfish person he’s ever met, etc. I really want to know what he can help and what he can’t! Again I appreciate your article knowing I’m not alone. Thanks!

Hi – I agree it is complicated and difficult, not minimizing this. But msinterpretation of what is happening, lack of educatio for carers etc does not help. An example is what seems like the ‘oh woe is me.’ this assumes the person has an attitude an approach when most likely they cant even do that any more, it is a left frontal lobe function. also when you cant problem solve the only thing you can do to solve your problems is to say them out loud. if someone else engages with this, then slowly and it can only be slowly, some things can move towards some improvement. it is like being blind – you need a mental guide dog. Or lame, you need a wheelchair. i have had a left frontal injury for 12 years. you are trying to solve your problems, but it is seen as a ‘bad attitude’ because you cannot solve it and keep repeating it until there is some help to progress. You are trying to communicate but problems with processing language and fatigue can make you exhausted and it looks just like someone obsessed with themselves, particularly as you cant change tack or flexibly flip to anothers point of view quickly. things are not what they seem. realising people are misinterpreting what is happening adds to the frustration. you are a caring brother, who has kept informed, and doing his best to help, but often practical explanations are few and far between and the brain injured person has great difficulty trying to explain. I find when people get it and see what is really happening, my symptoms are less and they get more what theyw ant to. when people go away they dont want to have to cope with it (understandable, who would, we dont want to either) but it helps the people withdrawing if they believe it is not the brain injury but the person’s approach to it, attitude. also when a person close to you changes there is grief which incloudes anger towards them which comes out in different forms. people seldom think of this but the people in our world have changed their behaviour greatly too, towards us, because of the demands of our injury, and we are in mourning too. That we cannot be ‘seen.’ Time does help. patience as you say. its a journey.

Amen jen… gotcha… I had a lesion that caused damage in my right frontal lobe and you put words to so much of what I have experienced… it has been an emotionally painful journey. Still, I am in awe of the brain and just how much it can compensate and how much the lobes do apparently interact. Much of my life has been set on a different path than before and I am having to learn how to gage instinct and emotion in different ways. I used to count to ten and now I do it twice. For all the ways I am different; I am still the same. It’s definately one of those deals where “You just gotta be there to really understand”. Bless you, I hope it goes well for you and that you will encounter people and circumstances that will help you along your way.

I have left anterior frontal lobe brain damage. After 18 years of coping with knowing my behavior wasn’t “me” and apologizing and apologizing to everyone, I found a new psychiatrist whose first words were to forgive myself and that I couldn’t be fixed. The old “me” was dead, grieve and accept. To stop the “poor me, I have a brain injury”, but to explain, and ask those who interact with me, (friends and family) to set boundaries and tell me when I am acting “off”. Communication is key. No fix all, but a beginning to a more peaceful life. I have left anterior frontal lobe brain damage. I understand the symptoms and behaviors after 18 years. This happened to me, it does not represent or define me. Author is correct, people keep trying to make you back into who you were and don’t understand you can’t.

My heart goes out to you all. I recently met a guy who suffered a frontal lobe injury in a vehicle accident. He understands a lot and seems to try to do things to cope. He understands and apologizes for his mishaps when he says or does something offensive. Ironically, I am a speech therapist and understand a great deal. I am able to patiently deal with him given my knowledge. We are friends and have been spending a lot of time together lately. It appears as though it could progress into something a bit more, however, we both have reservations. He expresses that he has a wall up because he doesn’t want to be hurt nor hurt me. This is something to strongly consider after all, no one looks to be hurt. Feedback from this forum would be appreciated as This is indeed a unique experience.

Roughly 4 years ago I was in a car accident that almost cost me my life. Having suffered what the doctors called ‘a severe head injury’ and being 30minutes away from dead and 15minutes from brain dead,(mostly to the front right) I pulled through and walked away with not a single sign of damage, other than a scar that hides under the hair on my head. As time progressed my long term relationship ended, and wanting to get away from it all I moved as far as I could, and started to retreat sociably. Not really remembering the ‘old me’, or maybe remember a version of who I thought couldve been the old me, this isolation really frustrated me. But I couldnt really break through as the social interaction was superficial mostly from my side. After much soul searching this year and having found someone that has really been an incredible source of wisdom and insight and understanding into this, I came across a book: The Brain That Changes Itself, by Norman Doidge. Not much of a spoiler but let’s just say there is hope, the brain can be rewired. It ain’t over till the fat lady sings, people. I feel for you and share your troubles, as they are some of the worst no one could ever imagine. Best wishes for you all

I have a daughter who received a severe difused Anoxial Brain injury 8 years ago. she was paralyzed and a mute. she is getting better physically but behaviorally is getting worse. she has assaulted her assistant she has injured myself in her outbursts. there are some triggers but mostly unpredictable onsets. It tears me up to see this sweet young woman of 25 behave so badly and I know she doesn’t like it. She also has memories that are not hers and yet she believes them to be hers. some are very harsh and traumatic in themselves and these cause her upsets. I can find no help in our area. what do we do to assist these folks in learning to control or know when it may hit. To protect them and others?

Hello. I lived 46.5 yrs. with a Hole in my right frontal lobe of my brain UNKNOWN TO ME. A genetic birth defect called a Cavernous Malformation. It looks like a hole on the M.R.I.. I have pieced together my life retro- spectively, since neurosurgery for removal, and see clearly just how much that hole in my brain affected every aspect of my life. Imagine living the first 46.5 years of your life thinking you were a bad person. I have written my memoirs autobiography to help people who were and are labelled and misunderstood. Blessings to all. Joel.

So I reckon not a lot of people read this page, and if they do, they don’t really comment. But just to reiterate what I’ve said previously. The brain isn’t hardwired. Those are all old teachings and was a part of the ‘evolutionary step’ in our understanding of how the brain, and consequently our mind works. http://en.wikipedia.org/wiki/Neuroplasticity – is a perfect example of the book’s content (The Brain that changes itself – Norman Doidge). I have spent thousands of hours researching and looking into, firstly recovery, and secondly self improvement in terms of what I may or may not have suffered with my brain injury (had a glascow count of 5/15 – I believe at 3 or 4 you are considered brain dead). The amount of research that is going on in neurology and the related fields are staggering, so do yourself a favour and look into that. Start with TEDtalk or some of the following books:

The Brain That Changes Itself – Norman Doidge M.D.
The Woman Who Changed Her Brain – Barbara Arrowsmith-Young
My Stroke of Insight – Jill Bolte Taylor Ph.D.
The Man with a Shattered World: The History of a Brain Wound – Aleksandr R. Luria (This one might be a bit heavy to read)

Not that anyone should care, but I will (hopefully) be starting next year at a very prestigious university to study Psychology with the aim to end up in Clinical Neuropsychology. We are bigger than this thing, and believe when I say that I might not understand your struggles, but I am well aware of what struggles there are.